Quick Treatment of Very Severe Refractory Hand and Foot Eczema with Dupilumab: A Case Report and Literature Review

Figures & data

Figure 1 Clinical improvement of patients after 6 weeks of dupilumab treatment. (A and B) at baseline; (C and D) after 6 weeks of treatment.

Table 1 Published Patient Cases with Hand Eczema Treated with Dupilumab

Study Type	Age (Years)	Sex	HE Type	Duration of Hand Eczema	Personal History of Atopy	Skin Lesions Localizations	Family History of Atopy	Prior Treatments	Response to Dupilumab*	Dupilumab-Associated Adverse Events	Reference
Case report	50	Female	Chronic atopic HE	18 years	AD, asthma, rhinitis	NA	Yes	Emollients; potent TCS; PUVA; systemic drugs: alitretinoin, CyA, AZA, MPA, tacrolimus, MTX, CS	16w almost clear	NA	[9]
Case report	44	Female	DE	>2 years	Asthma	Palms and soles	NA	Antibiotics; systemic drugs: CS	6w pain disappear, 8w clear	Injection site pain and ongoing pruritic conjunctivitis	[10]
Case report	67	Male	Vesicular HE	>2.5 years	No	Palmar	No	Potency TCS, potassium permanganate baths, coal tar; NB-UVB; systemic drugs: MTX, AZA, CyA	2w improved, 4w clear, no recurrence after 3 months of therapy	NA	[11]
Case report	43	Male	Chronic irritant hand dermatitis	>10 years	No	Hand	No	TCS; systemic drugs: CS	1m improved, 5m clear	NA	[12]
Case report	12	Male	DE	6 months	AD in early childhood	Hand and foot	NA	TCS, antimicrobials; UVA; systemic drugs: prednisolone, MTX, CyA, antimicrobials	4m complete stable remission	No	[13]
Case report	29	Female	HE without AD	5 years	No	Hand	No	TCS, Pimecrolimus; systemic drugs: histamine H1 receptor antagonists	4w improved; 16w almost healed	No	[14]
Case series	72	Female	HE without AD	>35 years	No	Palmar	NA	Topical clobetasol, tacrolimus; systemic drus: CS, thalidomide, MTX, MMF, CyA	6w complete clearance; 3m response maintained	NA	[15]
	65	Female	HE without AD	>10 years	No	Palmar	NA	Topical clobetasol, tacrolimus; systemic drugs: CS, CyA, MTX, prednisone	1w improved; 6w clear	NA	[15]
	48	Male	HE without AD	9 years	No	Palmar	Sister with hay fever	Topical clobetasol, tacrolimus; systemic drugs: apremilast, ustekinumab, MMF	3m 80% improvement; 8m response maintained	NA	[15]
Case series	38	Male	DE	5 years	NA	Hand and foot	NA	Topical clobetasol; PUVB; systemic drugs: acitretin	1w improved; 6w clear	NA	[16]
	38	Male	DE	several years	NA	Hand and foot	NA	Systemic drugs: prednisone, apremilast	6w improved combined with UVB	NA	[16]
Case series	63	Male	DE	>11 years	AD with asthma, seasonal allergies	Hand	NA	High-potency TCS, emollients; NB-UVB, PUVB, excimer laser; systemic drugs: CS, apremilast, MTX	8w improved	NA	[17]
	37	Male	DE	NA	AD in childhood	Palms and soles	NA	PUVB; systemic drugs: efalizumab, etanercept, adalimumab, apremilast, ixekizumab, MTX	4m completely free of disease	NA	[17]
Case series	65	Male	HHE	4 years	No	Hand	NA	Ultra-potent TCS; systemic drugs: alitretinoin, acitretin, MTX	16w minimal improved	NA	[18]
	47	Male	HHE	9 years	No	Hand	NA	Ultra-potent TCS; systemic drugs: alitretinoin, acitretin, CyA, MTX	4w improved; 16w clear	NA	[18]
	65	Female	HHE	4 years	Allergic rhinitis	Hand	NA	Ultra-potent TCS; systemic drugs: alitretinoin, AZA	4w improved; 16w clear	NA	[18]
Case series	Mean 56, range 32–76	10 males, 5 females	DE	NA	Without AD	NA	NA	TCS; oral immunosuppressive, phototherapy; psoriasis related biologic medications	All patients partial response; 40% patients complete clearance	2 facial redness; 1 ocular surface disease	[19]
Prospective observational study	>18, mean 45.2, range 20–69	32 males, 15 females	35 patients with chronic fissured, 12 patients with recurrent vesicular	27.4 (0–68) years	AD	NA	NA	Systemic drugs: cyclosporine, prednisolone, MTX, AZA, alitretinoin, MPA, MMF, tacrolimus	16w: HECSI-50 87%; HECSI-75 60%; HECSI-90 32%; DLQI reduction: 70.0%; PG responders (two steps improvement or more): 38%.	NA	[20]
Prospective observational study	>18, 45.2±13.0	48 males, 24 females	50 patients with chronic fissured, 22 patients with recurrent vesicular	26.9 ± 18.4 years	AD	NA	NA	Systemic drugs: CyA, prednisolone, MTX, AZA, alitretinoin, MPA, MMF, tacrolimus	52w: HECSI-75 87.1%; HECSI-90 62.9%; PG achieved “clear” or “almost clear” and ≥ 2 steps improvement: 67.7%; QOLHEQ reduction 63.5%.	Conjunctivitis or conjunctivitis with limbitis; multiple verrucae filiformes; blood eosinophilia	[21]
Retrospective review	42.2±18.4	15 males, 23 females	DE, AD, contact dermatitis	NA	AD	6 patients only hand, 32 patients hand and body involve	NA	Systemic drugs: prednisone, MMF, CyA	>4m: pruritus improved 96.7%; pain improved 100%; hand fissuring improvement: 28.9%.	NA	[22]

Note: *m and w mean months and weeks.

Abbreviations: AD, atopic dermatitis; HHE, hyperkeratotic hand eczema; HE, hand eczema; DE, dyshidrotic eczema; PUVA, psoralen ultraviolet-A; NB-UVB, narrowband ultraviolet-B; PUVB, psoralen ultraviolet-B; HECSI, Hand Eczema Severity Index; QOLHEQ, Quality of Life in Hand Eczema Questionnaire; NA, not available; TCS, topical corticosteroids; CS, corticosteroids; MTX, methotrexate; CyA, cyclosporine; MMF, mycophenolate mofetil; MPA, mycophenolic acid; AZA, azathioprine; PG, photographic guide.

Oosterhaven JAF, Romeijn GLE, Schuttelaar MLA. Dupilumab treatment of very severe refractory atopic hand eczema. JAMA Dermatol. 2018;154(8):969–970. doi:10.1001/jamadermatol.2018.2027

 PubMed Web of Science ®Google Scholar

Nanda S, Nagrani N, MacQuhae F, Nichols A. A case of complete resolution of severe plantar dyshidrotic eczema with dupilumab. J Drugs Dermatol. 2019;18(2):211–212.

 PubMed Web of Science ®Google Scholar

Halling AS, Zachariae C, Thyssen JP. Severe treatment-resistant acute and recurrent vesicular chronic hand eczema successfully treated with dupilumab. Contact Dermatitis. 2020;83(1):37–38. doi:10.1111/cod.13501

 PubMed Web of Science ®Google Scholar

Zhu GA, Honari G, Ko JM, Chiou AS, Chen JK. Dupilumab for occupational irritant hand dermatitis in a nonatopic individual: a case report. JAAD Case Rep. 2020;6(4):296–298. doi:10.1016/j.jdcr.2020.02.010

 PubMedGoogle Scholar

Weins AB, Biedermann T, Eyerich K, Moeckel S, Schnopp C. Successful treatment of recalcitrant dyshidrotic eczema with dupilumab in a child. J Dtsch Dermatol Ges. 2019;17(11):1165–1167. doi:10.1111/ddg.13929

 Web of Science ®Google Scholar

Gan H, Gao YD. Occupational chronic hand dermatitis in hospital environment successfully treated with dupilumab: a case report. Iran J Allergy Asthma Immunol. 2022;21(4):484–487. doi:10.18502/ijaai.v21i4.10296

 PubMed Web of Science ®Google Scholar

Matthew J, Zirwas MD. Dupilumab for hand eczema. J Am Acad Dermatol. 2018;79(1):167–169. doi:10.1016/j.jaad.2018.02.073

 PubMed Web of Science ®Google Scholar

Gall RA, Peters JD, Brinker AJ. Two cases of recalcitrant dyshidrotic eczema treated with dupilumab. J Drugs Dermatol. 2021;20(5):558–559. doi:10.36849/JDD.5273

 PubMed Web of Science ®Google Scholar

Weston GK, Hooper J, Strober BE. Dupilumab in the treatment of dyshidrosis: a report of two cases. J Drugs Dermatol. 2018;17(3):355–356.

 PubMed Web of Science ®Google Scholar

Loman L, Diercks GFH, Schuttelaar MLA. Three cases of non-atopic hyperkeratotic hand eczema treated with dupilumab. Contact Dermatitis. 2021;84(2):124–127. doi:10.1111/cod.13693

 PubMed Web of Science ®Google Scholar

Waldman RA, DeWane ME, Sloan B, Grant-Kels JM, Lu J. Dupilumab for the treatment of dyshidrotic eczema in 15 consecutive patients. J Am Acad Dermatol. 2020;82(5):1251–1252. doi:10.1016/j.jaad.2019.12.053

 PubMed Web of Science ®Google Scholar

Oosterhaven JAF, Voorberg AN, Romeijn GLE, de Bruin-Weller MS, Schuttelaar MLA. Effect of dupilumab on hand eczema in patients with atopic dermatitis: an observational study. J Dermatol. 2019;46(8):680–685. doi:10.1111/1346-8138.14982

 PubMed Web of Science ®Google Scholar

Voorberg AN, Romeijn GLE, de Bruin-Weller MS, Schuttelaar MLA. The long-term effect of dupilumab on chronic hand eczema in patients with moderate to severe atopic dermatitis-52 week results from the Dutch BioDay registry. Contact Dermatitis. 2022;87:185–191. doi:10.1111/cod.14104

 PubMed Web of Science ®Google Scholar

Lee N, Chipalkatti N, Zancanaro P, Kachuk C, Dumont N, Rosmarin D. A retrospective review of dupilumab for hand dermatitis. Dermatology. 2019;235(3):187–188. doi:10.1159/000496481

 PubMed Web of Science ®Google Scholar